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PERMIT APPLIC�fl,TION <br />CITY OF EVERETT PERMIT SEFtVICES <br />3200 CEDAR STREEf, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - www.everettwa.o: g a,.�G �p � <br />APPLICATIONS ARE ACCEPTED FROM 8{IM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRCSS <br />]60 ( Evv�z-L-iLEr�,✓ <br />lEG LOT NQ. <br />OESC. <br />PARCEL TAX I.D. i{ PERMIT tl <br />'✓f�Y#'E1 �`50S-c%Oc3J i�J�7C7 ��D 1 <br />o� <br />.. CK TRACT <br />C e L+-i h �-�-r� C R S� r1 �� �. .; . i3� �C %%° �0 3 0 � n-N lr,,.T� Ns� TX <br />,�� � A 7, sF t�� c; 7� z?9 <br />TENANiNAME '���y,T✓ CONTACTFORPERMiT PHONE <br />p�t,.�/}�ti- P�<<5 9 Si'�.,�LE "(%�-FlVzs �,�✓���.n-w�,>� ;���-S�-z-4737 <br />CONTRACTOR <br />SN��LE�s,�s syc,� <br />CONTR. LICENSE # <br />5{o,v.ESA`i°�IS�✓ 'F <br />USE OF BUILDING <br />ADDRESS CITY2IP PHONE <br />`j- A �.-NT-.✓ � � � � 1� /i�..l IL���t'I� F}Vf, N <br />SNop-E<.�-,�i � wr1 Y5�33 J�G -S�F�-$'737 <br />IG�o6 <br />HEATSOURCE <br />_ Eleclnc _ Gas _ Other <br />CONTRACT PRICE OF WOR!( <br />�+ / %CJ, c0 <br />WORK DESCRIPTION <br />.i!-RTG /�-ND =:�;✓S'�la� �'l. S-r✓ DJVJ-D �, r7� L .i= C.l. �� .�.5-�•� �i.—i�.iJ G{fA�v,-`-'£ L <br />(�Y8 /L <br />Lc��%�t- s � [ r�. <br />MtGF1ANIGAL <br />NO. I TYPE OF FIXTURE OR ITEM I NO. I TYPE OF FlXTURE OR ITEM <br />Toilel <br />Bathtub <br />Lavalory (wash basin) <br />Sho'.ver <br />Kilchen sink 3 disposal <br />Dishwasher <br />Clolhes washer <br />Laundry tray <br />Sink (service/badmop/etcJ <br />Backilow preventer <br />Urinal <br />Drinking Fountain <br />Floor tlrain <br />Grease trap <br />Roof drains <br />Other <br />A/C - air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas ranpe <br />Clolhes dryer <br />Ranpe hood <br />Exhaustfan <br />Heal pump <br />Unil heater <br />Boiler <br />Retrigeration <br />Woodslove <br />Olher <br />CITY OF EVERETT LOCAL SALES 7AX CODE IS 3105 <br />I herby ceritify that I have read and examined this applicalion and know the same to be true and corred. All pmvisions of laws and <br />ortfinaces goveming ihis type of work will be complied wilh whether specified herein or not. The gianling of a permit does not piesume <br />to S; a authority to violale or cancel fhe provisico of any olher state or Iocal law regulating wnstrudion or the pertomiance of <br />construdion. Thal I am authorized by the owner of this property to perform the work for which application is made and I comply with the <br />Slate Contractors Law 18.27 RCW antl 296.200 WAC. <br />-, � ��,1..��.--�/ � l � 3/� � <br />Signature of OwnedContrador/AWhonzetl Aflent Date <br />I� <br />